upper abdominal mass
Introduction
Introduction Abdominal lesions caused by various reasons, palpation has mass. Common in liver cirrhosis, chronic pancreatitis, stomach cancer, gallbladder cancer and other diseases. May be related to inflammation, trauma, etc. caused by limited blood supply reduction or vascular malformation caused by hepatocyte atrophy and compensatory proliferation of liver tissue. Due to the development of imaging technology in recent years, the report of focal nodular hyperplasia of the liver is gradually increasing. .
Cause
Cause
Common causes of abdominal mass: The nodules are composed of proliferating hepatocytes. The liver cells are rich in glycogen and the cytoplasm is lightly stained, arranged in a strip shape with sinusoids and hepatic macrophages in between; and the radial fibrous tissue is separated into hepatocytes, and the fibrous tissue usually contains one or several pieces. Arteries, arterial intima or mid-fibrosis muscle layer often show mild hyperplasia; there are hyperplastic bile ducts in the fiber separation, and a large number of blood vessels and lymphocytes, leukocyte infiltration; often see different degrees of cholestasis (capillary bile duct thrombus, Pseudoxanthosis, copper deposition); necrosis and hemorrhage are rare in the lesion.
(1) pathological enlargement of parenchymal organs: liver, spleen, kidney, pancreas and lymph nodes due to various reasons;
(2) expansion of the hollow organ;
(3) inflammatory masses;
(4) benign and malignant tumors;
(5) Parasites.
Examine
an examination
Related inspection
Percutaneous diagnosis of abdominal organs by fiberoptic endoscopy
Pay attention to the following points when touching the abdomen mass:
(1) Location: The mass in some locations is often derived from the organs of the Ministry. In the middle of the abdomen, the mass is often a tumor of the stomach or pancreas, a cyst or an intragastric stone; the right subcostal mass is often associated with the liver. Related to the gallbladder; the masses on both sides of the abdomen are often tumors of the colon; the irregular or tender mass of the umbilicus or the right lower abdomen is often intestinal adhesion caused by tuberculous peritonitis; the lower abdomen is round, movable, and tender. The mass may be a swollen lymph node. If there is a deep, hard and irregular mass, it may be a retroperitoneal tumor. The ovarian cyst is pedicled, so it can swim in the abdominal cavity. The mass above the inguinal ligament may come from the egg set. And other pelvic organs.
(2) Size: All the blocks that are touched should be measured at the top (longitudinal), left and right (width) and anteroposterior (deep). When the anteroposterior diameter is difficult to measure, it can be estimated roughly, and the size is clear for dynamic observation. . For the sake of simplicity and image, you can also use the analogy of the size of the real thing, such as eggs, fists, walnuts and so on. Huge masses occur in the visceral organs such as the ovary, kidney, liver, pancreas and uterus, and most of them are cysts. Post-membranous lymph node tuberculosis and tumors can also reach a large extent. The gastrointestinal mass rarely exceeds the transverse diameter of the lumen, because obstruction has occurred without the length of the transverse diameter. If the size of the mass varies, or even disappears by itself, it may be caused by sputum and dilated intestinal fistula.
(3) Form: When touching the mass, attention should be paid to its shape, contour, edge and surface condition. Regular round and smooth surface masses are mostly benign, mostly cysts or lymph nodes; irregular, uneven surface and hard, should consider malignant tumors, inflammatory masses or tuberculous masses; strips or tubes Tumors, which are morphologically variable in a short period of time, are mostly mites or intussusception. The right upper abdomen touches a smooth oval-shaped mass, which should be suspected as gallbladder effusion. The left upper abdomen mass has obvious obvious spleen.
(4) Texture: If the mass is substantial, its texture may be flexible, moderately hard or hard. It is found in tumor, inflammatory or tuberculous infiltrates, such as gastric cancer, liver cancer, and ileocecal tuberculosis. If the mass is cystic, the texture is soft, found in cysts, pus, such as ovarian cysts, polycystic kidneys and so on.
(5) tenderness: the inflammatory mass has obvious tenderness. For example, the mass in the right lower abdomen is obvious, often including appendix abscess, intestinal tuberculosis or Crohn's disease. Tumor tenderness associated with organs can be light and heavy.
(6) Mobility: If the mass moves up and down with breathing, mostly liver, spleen, stomach, kidney or its mass, the gallbladder is attached to the liver, and the transverse colon is connected to the stomach by the stomach ligament, so its mass Also go up and down with your breath. The movement of the liver and gallbladder is large and it is not easy to fix by hand. If the mass can be pushed by hand, it may come from the stomach, intestines or mesentery. Most of the movements are pedicled masses or organs that swim. Local inflammatory mass or pus and tumor of the posterior wall of the abdomen can not generally move.
(7) Pulsation: A thin person can see or touch the beat of an artery in the abdomen. Aneurysms of the abdominal aorta or its branches should be considered if a significant enlargement is accompanied by an expansional pulsation near the midline of the abdomen.
In addition, attention should be paid to the relationship between the block and the abdominal wall and the skin to distinguish the lesions inside and outside the abdominal cavity.
Diagnosis
Differential diagnosis
Common masses in various areas of the abdomen:
(1) common mass in the upper abdomen: gastric cancer, pancreatic cancer and cyst, left hepatic lobe cancer;
(2) common mass in the left upper abdomen: mainly swollen spleen, kidney and transverse colon spleen and pancreatic tail cancer;
(3) common mass in the right upper abdomen: liver, gallbladder, right kidney enlargement and colonic hepatic cancer;
(4) common mass in the umbilicus: adhesion block caused by tuberculous peritonitis, mesenteric lymph node tuberculosis or tumor, transverse colon mass and mites group;
(5) common mass in the left lower abdomen: sigmoid colon cancer, schistosomiasis, left ovary or fallopian tube mass;
(6) common mass in the right lower abdomen: inflammatory lesions of the cecum, appendix, abscess, tumor and right ovary or fallopian tube mass;
(7) common mass in the lower abdomen: inflated bladder and bladder tumors, pregnant uterus and uterine tumors.
